J Thorac Cardiovasc Surg 2006;131:929
© 2006 The American Association for Thoracic Surgery
Reply to the Editor
Ina Michel-Behnke, MD,
Hakan Akintuerk, MD,
Dietmar Schranz, MD
Pediatric Heart Center, Justus-Liebig University, Giessen, Germany
Reply to the Editor:
We appreciate the thoughtful comments of Corno and associates
1
about our recent study. The exciting results pointing out the advantages of the FloWatch-PAB
2,3
forced us to use this device in the case presented. Because of the localization of the ventricular septal defect in the muscular septum, increased pulmonary artery pressure and the patient's young age made us optimistic that the adjustable FloWatch banding device would be the ideal solution for this patient. For this reason, we avoided a conventional banding as suspected by the authors, and even looking thoroughly at all available intraoperative images, we are not able to visualize surgical damaging of the pulmonary artery trunk before placement of the device. After removal, the device was carefully studied for any sharp edges that might have occurred during the manufacturing process and could have been responsible for the observed pseudoaneurysm formation, which could be ruled out.
However, the early detection of pericardial effusion and the loss of the banding effect suggest some damage to the integrity of the vessel wall while the aneurysm was detected on radiography only 7 weeks later. Therefore we are confident that the patient had a real complication rather than a coincidence. We agree that the physical properties of the FloWatch-PAB, especially the maintenance of the circumferential length of the pulmonary artery, should be helpful to prevent the complications of conventional banding procedures. Our personal experience in 2 other patients with multiple ventricular septal defects, in whom we removed the device 16 and 27 months after placement, respectively, support the usefulness of this new medical implant. Nevertheless, facing even rare complications, as we described, should contribute to increase patient safety.
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References
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- Michel-Behnke I, Akintuerk H, Valeske K, Thul J, Mueller M, Schranz D. Pseudoaneurysm of the pulmonary trunk after placement of an adjustable pulmonary artery banding device (FloWatch-PAB) in a patient with muscular ventricular septal defect. J Thorac Cardiovasc Surg. 2005;130:894-895.[Free Full Text]
- Corno AF, Bonnet D, Sekarski N, Sidi D, Vouhe P, Von Segesser LK. Remote control of pulmonary blood flow. initial clinical experience. J Thorac Cardiovasc Surg. 2003;126:1775-1780.[Abstract/Free Full Text]
- Corno AF, Sekarski N, Bernath MA, Payot M, Tozzi P, Von Segesser LK. Pulmonary artery banding. long-term telemetric adjustment. Eur J Cardiothorac Surg. 2003;23:317-322.[Abstract/Free Full Text]
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References